Intake Form
Namaste!

The answers you provide to the following questions are SO IMPORTANT for me to give you the best information- tailored specifically to YOU- to help you through virtually ANY AND EVERY THING as we move forward navigating this carnation together- especially during such a chaotic and critical time period for all of humanity!

There could be any number of reasons why you are sitting where you are about to fill out this form; one thing I know for sure is that I do not believe in coincidences! I am also convinced that the people we meet, the conversations we have, and the ideas we exchange along the way happen when and as they should!

I am absolutely thrilled to offer a space where we can openly and holistically explore our individual and collective human psyche so that EVERYONE benefits. Despite what you have been lead to believe, it IS possible!! The metaphysical concepts and tools I want to share with you will change your life, filling you with confidence and reassurance as you move into alignment with your TRUE SELF for the greater good of all- the only means of achieving true, authentic, deeply seated peace and happiness!!

For the purpose of our work together, I offer guidance from a non-denominational perspective- meaning I do not teach or discuss any one religion in particular. I want to clarify that I have no need for asserting any deity or ideology as supreme to another. As a show of my earnest curiosity and willingness to discuss this sensitive topic in a 100% judgement-free zone with absolutely no intention of "converting you" to my own beliefs, I offer the response I would provide to the inquiry of my own spiritual/religious background:

-I was baptized Catholic and accompanied my grandmother to Sunday services often. Marriage and funeral services I witnessed have typically been Catholic or Christian. I took myself to local Lutheran church services, attended vacation bible school every summer, and enjoyed Wednesday Bible group for several years. I was unable to finish the final year in order to receive my first communion with my peers, but I identified as a Christian most of my adult life. It wasn’t until recently, after a series of tragedies forced me to examine my own beliefs, when I was guided on a journey to "re-discover" my pagan beliefs that urged me to commit and formally dedicate myself as a practicing Wiccan-

Please feel welcome to share your any details that you feel compelled to share with complete confidence that your secret is safe with me ;-)

I look forward to working with you!
Email *
Name: *
DATE OF BIRTH *
TIME OF BIRTH. If you are unsure of the exact time, please offer your best guess even if you are only able to offer a general clue like morning or late afternoon. This does affect more intricate details, particularly in your birth astrological chart. For this reason, I would be unable to provide a complete natal profile without further investigation and discussion. You can obtain this information by requesting a copy of your birth record. If you need further assistance with this, please let me know here: *
DO YOU KNOW THE EXACT OFFICIAL TIME OF YOUR BIRTH? Using the time you were born, I am able to develop a chart of the sky at the exact time you were born.
Column 1
Yes
No
BIRTH CITY, STATE, COUNTRY (if outside US). The place where you were born affects the house placement and position of the planetary bodies, determines daylight savings time zone, and it is used to calculate Universal Time. *
FULL NAME AT BIRTH. If you have special circumstances regarding your name at birth, or any of the above information, as it was written on your birth certificate, please discuss that here:
HOW WOULD YOU INTRODUCE YOURSELF... At an interview? To a new friend at a party? Current or significant recent nickname? Pen or Surname?
ANY LEGAL CHANGES FROM YOUR BIRTH NAME? Due to marriage, divorce, petition for name change, etc.
ARE YOU INTERESTED IN ANY PARTICULAR SERVICE AT THIS TIME?
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DO YOU HAVE ANY ALLERGIES, ASTHMA, OR ANY OTHER BREATHING ISSUES/SENSITIVITIES? Aromatherapy is part of every face-to-face session. I often cleanse the area with sage smudging before hand and may burn other herbs or resins during the session as part of a holistic experience that stimulates all the physical senses. However, I will gladly make  accommodations for clients that these practices may cause issues for, such as airing out the space and thoroughly wiping down any contact surfaces with a hypoallergenic, all natural cleaning solution or arranging an alternate location. If at any time you become short of breath or find the odors offensive, please let me know as soon as possible.
DO YOU BELONG TO ANY RELIGIOUS GROUPS OR INSTITUTIONS? Do you currently or have you ever attended a church or religious training? What about your parents- were they active members of any church or religious group? Answering this question is completely optional. I urge you to share your religious background so I have a general idea of your knowledge base.
WHAT'S ON YOUR MIND CURRENTLY? Is there a specific area of your life that you are seeking clarity with or having trouble with particularly? Keep in mind it is 100% OKAY and COMPLETELY NORMAL to check two, three, all the boxes. The struggle is real, and it is real for everyone. No need to compare apples and oranges. Once again, no judgement here.
WHAT SYMPTOMS ARE YOU CURRENTLY EXPERIENCING? Rate the severity.
Mild
Moderate
Severe
Depression
Anxiety
Indecisiveness
Lack of interest in usual activities
Losing track of time
Confusion
Moodiness
Frustration
Low self-esteem
Irritability
Feelings of emptiness
Feeling some thing is missing
Loss of direction
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DO YOU HAVE ANY OTHER COMMENTS, QUESTIONS, OR CONCERNS? This is your opportunity to share anything or ask any question that I haven't addressed. I appreciate your feedback on the content I have published on my website and welcome constructive criticism!
WHO REFERRED YOU? I always feel both humbled and incredibly blessed when people are so positively affected by  me that they share it with others and send new friends my way. Thank you for telling me who sent you so I can shower them with gifts and tokens of my appreciation!!
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